Articles in The Lancet have reminded us of the seriousness of the global problem of preterm births which lead to 1.1 million infant deaths annually and is the second biggest cause of child deaths (those below 5 years old) after pneumonia. With over 11% of the world’s babies being “born too soon“, this is a problem of global magnitude.
Even higher income countries are affected, though in some instances it is a problem of their own making – preterm elective caesarian operations, multiple ovaries in assisted reproduction. Specifically for low/middle income and tropical countriesÂ the following was observed: “There are other preventive interventions, ranging from birth spacing to treating maternal infection, notably malaria, HIV, and syphilis, or improving nutrition, which are highly relevant for low-income and middle income countries.”
In her review of malaria in pregnancy Ruth Lagerberg observed that, “Adverse consequences of malarial infection during pregnancy include an increased risk of spontaneous abortion, preterm delivery, LBW, a two-fold increase in the risk for stillbirth regardless of parity, and congenital infection.”
WHO notes important malaria preventive measures that are supposed to be part of routine antenatal care in malaria endemic countries including at least two doses of intermittent presumptive treatment during pregnancy for malaria (IPTp) and the use of bednets and calls for continued research on the effectiveness of these interventions in reducing preterm birth. Fortunately data have been amassed over the years on this very topic.
A recent study in Mali demonstrated that 3 doses of IPTp during pregnancy cut the rates of low birth weight and prematurity in half. In Nigeria IPTp was found to be effective in preventing preterm delivery and low birth weight among pregnant women. In Gabon there was a marked benefit on the prevalence of low birth weight and premature birth for women adhering to national recommendations for IPTp.
Continued research has led WHO to recently recommended increase in the number of doses of IPTp in moderate to high endemic countries to receiving a dose at each ANC visit after quickening.
Malaria treatment should also be in the mix of antenatal interventions. Access to early diagnosis and treatment of malaria among refugees along the Thai-Burmese border was found to be a factor in decreasing low birth weight and prematurity.
The argument has always been made that since most pregnant women in malaria endemic areas of Africa attend antenatal care, it should be possible to reach them with malaria prevention and treatment interventions. Unfortunately coverage of malaria control measures for pregnant women remains low showing that health systems are not working for pregnant women. Greater priority is therefore needed on this neglected portion of the population at risk from malaria.